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1 | AN ACT concerning provider billing.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by adding | ||||||||||||||||||||||||
5 | Section 368f as follows: | ||||||||||||||||||||||||
6 | (215 ILCS 5/368f new)
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7 | Sec. 368f. Requirement to enable electronic exchange of | ||||||||||||||||||||||||
8 | information. | ||||||||||||||||||||||||
9 | (a) An accident and health insurer licensed in Illinois | ||||||||||||||||||||||||
10 | shall have the
ability to accept health claims
or equivalent | ||||||||||||||||||||||||
11 | encounter information, referral certification, authorization, | ||||||||||||||||||||||||
12 | and
eligibility transactions
electronically and shall utilize | ||||||||||||||||||||||||
13 | the federal standards for these electronic
transactions | ||||||||||||||||||||||||
14 | established by
the Department of Health and Human Services | ||||||||||||||||||||||||
15 | pursuant to Section 262 of
Pub.L. 104-191 (42
U.S.C. 1320d et | ||||||||||||||||||||||||
16 | seq.) and Part 162 of Title 45, Code of Federal Regulations. | ||||||||||||||||||||||||
17 | A health care professional or health care facility that is
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18 | licensed to provide health care
services in Illinois and that | ||||||||||||||||||||||||
19 | accepts patients who are enrolled in an
individual
health plan | ||||||||||||||||||||||||
20 | or a group
health plan, including a health insurance issuer | ||||||||||||||||||||||||
21 | offering coverage through the
group health plan,
Medicaid, or | ||||||||||||||||||||||||
22 | the State employee health plan shall submit health claims or
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23 | equivalent encounter
information, referral certification, | ||||||||||||||||||||||||
24 | authorization, and eligibility
transactions
electronically and | ||||||||||||||||||||||||
25 | shall
utilize the federal standards for these electronic | ||||||||||||||||||||||||
26 | transactions established by
the Department of
Health and Human | ||||||||||||||||||||||||
27 | Services pursuant to Section 262 of Pub.L. 104-191 (42
U.S.C. | ||||||||||||||||||||||||
28 | 1320d et seq.)
and Part 162 of Title 45, Code of Federal | ||||||||||||||||||||||||
29 | Regulations. | ||||||||||||||||||||||||
30 | (b) The Department shall establish a
timetable
for | ||||||||||||||||||||||||
31 | implementation of the electronic transmission of health care | ||||||||||||||||||||||||
32 | transactions.
The timetable shall
not require implementation |
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1 | prior to the compliance date set forth by the U.S.
Department | ||||||
2 | of Health
and Human Services for federal standards for | ||||||
3 | electronic health care
transactions pursuant to Section
262 of | ||||||
4 | Pub.L. 104-191 (42 U.S.C. 1320d et seq.) and Part 162 of Title | ||||||
5 | 45, Code
of Federal
Regulations or any extension granted by the | ||||||
6 | Secretary of Health and Human
Services to comply with
the | ||||||
7 | federal standards. | ||||||
8 | (c) The Director may temporarily waive the application of | ||||||
9 | this Section in
cases in which:
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10 | (1) there is no method available for the submission of | ||||||
11 | claims in an
electronic
form; or
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12 | (2) the entity submitting the claim is a small health | ||||||
13 | care professional or
health care facility
with fewer than | ||||||
14 | 10 full-time equivalent employees that has demonstrated | ||||||
15 | that
compliance with
this Act will result in an undue | ||||||
16 | hardship or other special circumstance on the
health care | ||||||
17 | professional
or health care facility.
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18 | (d) The Department
shall establish an application and | ||||||
19 | review process for health care
professionals and health
care | ||||||
20 | facilities with identified special circumstances no later than | ||||||
21 | 6 months
prior to the effective date
of implementation as | ||||||
22 | determined under subsection (b).
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23 | (e) The Department
shall
report to the Governor and the | ||||||
24 | General Assembly within one year after
establishing the
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25 | timetable pursuant to
this Section, and at least annually | ||||||
26 | thereafter, on the number of extensions
or temporary waivers of
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27 | the implementation requirement that it has granted pursuant to
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28 | subsection (c), the
reasons therefor, and recommendations to | ||||||
29 | overcome obstacles to full compliance
by affected health
care | ||||||
30 | professionals and health care facilities.
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31 | (f) Beginning
January 1, 2005, an individual health plan or | ||||||
32 | a group health plan,
including a health insurance
issuer | ||||||
33 | offering coverage through the group health plan, or a state | ||||||
34 | agency
administering a
government health plan, may not deduct | ||||||
35 | more than a $2 per claim service fee
for adjudication of
any | ||||||
36 | paper health claims. |
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1 | (g) This Section does not apply to long-term care | ||||||
2 | facilities licensed under the Nursing Home Care Act or to | ||||||
3 | community-integrated living arrangements operated under the | ||||||
4 | Community-Integrated Living Arrangements Licensure and | ||||||
5 | Certification Act.
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6 | Section 99. Effective date. This Act takes effect upon | ||||||
7 | becoming law.
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